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BUSINESS CERTIFICATE# 101-i- "d y3 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE / J` <br /> DATE <br /> • Expiration Date: 6/ e) A& <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> undersigned hereby declare(s) that a blusines under the title of 11 J <br /> Business Name/DBA: ANT // J N/l� Corporation Name: J A n tUtT NN <br /> ��• <br /> is conducted at Business Location: l9 Pta'1 M07,4V,, r�/)-) Commercial_Ressiidennttial_ <br /> Business Mailing Address: /��b FA)MOA� P'U i' / M5A0&'0 1;P <br /> p 'ZV 4; p <br /> Business Type: � \Ae1 l / vtoVell .C1 4Y,4 Business Telephone: 5_0 / 619 OI_q 9S l —1 <br /> New Renewal �ome Phone: [J V dyy r3 6 Email Address: Pe. of �(l�'r7�/✓?VtT N�'� <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> f N- M)eruaano� l76 Glarns �ue�� Cot,eQ� � oS6�5 <br /> I cern under the penalties of perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> tax eq r d gpgeiJa3t <br /> �gE0 <br /> ature of authorized agent "Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> *This license will not be issued unless this certification is signed by applicant <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: <br /> Alarm Company: <br /> "Your.social security number will be furnished to the Massachusetts Departmeni of Revenue to determine whether you have met tax filing or tax <br /> payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth ojMassachusents <br /> BARNSTABLE ss ( DATE W2� <br /> Personally appeared before me the above-named FtTs/t r f.✓^— 06A1 <br /> 1� 0S and made oath that the foregoing statement is <br /> true. <br /> A ceWeed,c ordancc with this section shall be in force and effect (or four years from the a and shall be renewed <br /> each four years such business shall be conducted and shall lapse and be void unless so r- ewed. <br /> Signed <br /> SEAL JOSEPHL.�Pu .� <br /> ® SAY xpues: <br /> October 25.2013' <br />